NCM 112 – Cellular Aberration (9)  And also, there is no significant relation between

the experience and the knowledge score of the

Evidence-Based Practice (EBP) on Fluid and Electrolytes
samples and no significant relation between the
Sharing
area of work and the knowledge score of the
 A Study to Assess the Knowledge and Practices of samples. The observation revealed that in most of
Staff Nurses Regarding Fluid and Electrolyte the situations most of the criteria in fluid and
Administration in Post Operative Cardiac Surgical electrolyte administration were fulfilled.
Patients Admitted in Cardiac Surgical ICU and  Conclusion: A descriptive study was undertaken to
Cardiac Surgical Ward, SCTIMST, TVM assess the knowledge and practices of staff nurses
(By: Aswathy Vijayan, SREE Chitra Tiruna Institute for about fluid and electrolyte administration after
Medical Sciences and Technology, TRIV AND RUM, cardiac surgery among staff nurses in Cardiac
695011, November 2011) Surgical ICU and Cardiac Surgical Ward in SCTIMST,
Trivandrum. The study was conducted in a relatively
 Monitoring a patient’s fluid balance to prevent small sample of 40. This study clearly portrays that
dehydration or overhydration is a relatively simple fifty percentage of the nurses have above average
task, but fluid balance recording is notorious for knowledge about fluid and electrolyte
being inadequately or inaccurately completed administration after cardiac surgery.
(Bennet, 2010). A study by Reid (2004), which
audited the completion of fluid balance charts on  CELLULAR ABERRATION
different wards, found the major reasons fluid
balance charts were not completed appropriately
were staff shortages, lack of training, and lack of
time
 According to the nursing and midwifery council
(2007), record keeping is an integral part of nursing
care, not something to be “fitted in” where
circumstances allow. It is the responsibility of the
nurse caring for a patient to ensure observations
and fluid balance are recorded in a timely manner,
CANCER
with any abnormal findings documented and
 A large group of disease characterized by
reported to the nurse in charge (Scales and
uncontrolled growth and spread of abnormal
Pilsworth, 2008). The use of fluid balance charts
cells
that show cumulative input and output is now being
debated in the literature (Bennet, 2010). A recent
 Oncology Nursing
study by Perren et al (2011) suggested that for a
 Cancer nursing
large proportion of patients, especially those in
critical care, cumulative fluid balance charts are not
 Epidemiology
accurate and their use should be questioned
 In 2015, nearly 700,000 new cancer cases were
 Methodology: A survey approach was used for the
diagnosed
study. The structured knowledge questionnaire was
 In the same year, nearly 600,000 Americans
adopted to collect the data to assess the knowledge
died as a result of cancer
of staff nurses in fluid and electrolyte
 Despite significant advances in science and
administration. The sample size was forty. The
technology, cancer is the second leading cause
structured knowledge questionnaire consisted of 15
of death in the United States in 2015
questions and the time taken for the completion
 The global cancer burden is estimated to have
was about 10 minutes.
risen to 18.1 million new cases and 9.6 million
 And an observational schedule was used to assess
deaths in 2018, according to a new report
the practices of the staff nurses in intravenous fluid
released by the International Agency for
and electrolyte administration. Sixty different
Research on Cancer (IARC)
observations were done. The duration for each
 The report said 1 in 5 men and 1 in 6 women
observation was one hour.
worldwide develop cancer during their lifetime,
 Major Findings: The study findings showed that
and 1 in 8 men and 1 in 11 women die from the
50% of the samples have 76-100% of knowledge
disease. Worldwide, the total number of people
score, about 47.5% of samples have knowledge
who are alive within five years of a cancer
score of 51- 75% and 2.5% of samples have a
diagnosis, called the five-year prevalence, is
knowledge score of <50%. There is no significant
estimated to be 43.8 million
relation between the age and knowledge score of
 Cancers of the lung and female breast are the
the samples.
leading types worldwide in terms of the number
 of new cases. “For each of these types, CARCINOGENESIS
approximately 2.1 million diagnoses are Molecular Process:
estimated in 2018, contributing about 11.6  Malignant transformation, or carcinogenesis, is
percent of the total cancer incidence burden.” thought to be at least a three-step cellular
process, involving INITIATION, PROMOTION and
 The Leading Causes of Cancer Death in the U.S. in PROGRESSION
Order of Frequency and Location
In men:
1. Lung
2. Prostate
3. Colorectal
In women:
1. Lung
2. Breast
3. Colorectal cancer
- could be due to the food we eat

 Most cancer occurs in older adults; according to the

American Cancer Society (ACS), 78% of all cancer
diagnoses are in people 55 years of age or older
(2015)  CARCINOGENS
 Overall, the incidence of cancer is higher in men  Agents that initiate or promote malignant
than in women transformation.
 Substances that can cause cancer
 Pathophysiology of the Malignant Process  “Cancer-causing”
 Cancer is a disease process that begins when a cell
is transformed by genetic mutations of the cellular  During INITIATION, carcinogens such as
deoxyribonucleic acid (DNA) chemicals, physical factors, or biologic agents,
 Genetic mutations may be inherited and/or cause mutations in the cellular DNA.
acquired, leading to abnormal cell behavior  Normally, these alterations are reversed by DNA
 The initial genetically altered cell forms a clone and repair mechanisms or the changes initiate
begins to proliferate abnormally, evading normal programmed cellular death (apoptosis) or cell
intracellular and extracellular growth-regulating senescence
processes or signals as well as the immune system
defense mechanisms of the body
 Genetic mutations may lead to abnormalities in cell
signaling transduction processes (signals from
outside and within cells that turn cell activities
either on or off) that can in turn lead to cancer
development
 Ultimately cells acquire a variety of capabilities that
allow them to invade surrounding tissues and/or
gain access to lymph and blood vessels, which carry
the cells to other areas of the body resulting in
metastasis or spread of the cancer

 Characteristics of Malignant Cells  Cells can escape these protective mechanisms

 Benign and malignant cells differ in many cellular
growth characteristics, including the method and
rate of growth, ability to metastasize or spread,
destruction of tissue, and ability to cause death
 The degree of anaplasia (a pattern of growth in
which cells lack normal characteristics and differ in
shape and organization with respect to their cells of
origin) is associated with increased malignant
potential
with permanent cellular mutations occurring,
but these mutations usually are not significant
to cells until the second step of carcinogenesis
 During PROMOTION, repeated exposure to
promoting agents (co-carcinogens) causes
proliferation and expansion of initiated cells
with increased expression or manifestations of
abnormal genetic information, even after long
latency periods.
 Promoting agents are not mutagenic and do not
need to interact with the DNA
  Pathogenesis of Cancer
1. CELLULAR TRANSFORMATION AND
DERANGEMENT THEORY
 Conceptualizes that normal cells may be
transformed into cancer cells due to exposure to
some etiologic (carcinogenic) agents

 Latency periods for the promotion of cellular

mutations vary with the type of agent, the
dosage of the promoter, and the innate
characteristics and genetic stability of the target
cell.
2. FAILURE OF THE IMMUNE RESPONSE THEORY
 The promotion phase generally leads to the
 Our immune system fails or weakens
formation of preneoplastic or benign
 Advocates that all individuals possess cancer cells.
(noncancerous) lesion
However, the cancer cells are recognized by the
immune response system. So, the cancer cell
undergo destruction. Failure of the immune
response system leads to inability to destroy the
cancer cells (If you have a low immune system, you
will not be able to fight against the cancer cells
hence, you need to have a high immune response
system)

 Etiology
Factors known to induce carcinogenesis include:
 During PROGRESSION, the altered cells exhibit
1. Viruses and bacteria
increasingly malignant behavior. These cells
2. Physical agents
acquire the ability to stimulate angiogenesis
3. Chemicals
(growth of new blood vessels that allow cancer
4. Genetic or familial factors
cells to grow), to invade adjacent tissues, and to
5. Lifestyle factors
metastasize
6. Hormones

 Viruses and Bacteria

 It is estimated that about 11% of all cancers
worldwide are linked to viral infections (Schiller
& Lowy, 2014)
 After infecting individuals, DNA viruses insert a
part of their own DNA near the infected cell
genes causing cell division
 The newly formed cells that now carry viral DNA
lack normal controls on growth
 Examples of these viruses that are known to The extensive list of suspected chemical substances
cause cancer include: continues to grow and includes:
1. Human papillomavirus (HPV) (cervical 1. Aromatic amines and aniline dyes
and head and neck cancers) 2. Pesticides and formaldehydes (must protect our
2. Hepatitis B virus (HBV) (liver cancer) farmers)
3. Epstein-Barr virus (EBV) (Burkitt 3. Arsenic, soot, and tars
lymphoma and nasopharyngeal cancer) 4. Asbestos
(Chen, Hsu, Yang, et al., 2014) 5. Benzene
 There is little evidence to support the link of 6. Cadmium
most bacteria to cancer, although chronic 7. Chromium compounds
inflammatory reactions to bacteria and the 8. Nickel and zinc ores
production of carcinogenic metabolites are 9. Wood dust
possible mechanisms that continue to be 10. Beryllium compounds
investigated 11. Polyvinyl chloride
 Helicobacter pylori is one bacterium identified  Betel nut and lime, which are chewed as stimulants
as significant cause of gastric cancer (Bessede, in some cultures, are also included.
Dubus, Megraud, et al., 2014)
 Genetics and Familial Factors
 Physical Agents  Approximately 5-10% of cancers in adults display a
 Physical factors associated with carcinogenesis pattern of cancers suggestive of a familial
include: predisposition (NCI, 2016) – cancer can be inherited
1. Exposure to sunlight (Ultraviolet rays)  Examples include hereditary breast and ovarian
- avoid too much exposure to sunlight; Early cancer syndrome (BRCA1 and BRCA2) and multiple
in the morning like 7:00-8:30am and then endocrine neoplasia syndrome (MEN1 and MEN2)
late in the afternoon like 3:30-5:30pm but  Other cancers associated with familial inheritance
not in between those hours syndromes include:
2. Radiation – frequent X-ray examinations 1. Nephroblastomas
3. Chronic irritation or inflammation 2. Pheochromocytomas
4. Tobacco carcinogens 3. Colorectal cancer
5. Industrial chemicals and asbestos 4. Stomach cancer
5. Thyroid cancer
 Chemical Agents 6. Renal cancer
 Many cancers are thought to be related to 7. Prostate cancer
environmental factors (ACS, 2015). Most 8. Lung cancer
hazardous chemicals produce their toxic effects
by altering DNA structure  Lifestyle Factors
 Approximately one quarter to one third of all
TOBACCO SMOKE cancers in the U. S. have been linked to lifestyle
 Thought to be the single most lethal chemical factors, such as:
carcinogen, accounts for about one third of 1. Diet – some aren’t conscious of what they
cancer deaths (ACS, 2015) eat
 Every body part that gets passed by smoke can 2. Obesity
cause cancer (mouth, lips, trachea, lungs) 3. Insufficient physical activity – sedentary
lifestyle
SMOKING  These factors are second only to tobacco use as
 Is strongly associated with cancers of the lungs, major risk factors associated with cancer
head and neck, esophagus, stomach, pancreas, development (ACS, 2015)
cervix, kidney, and bladder and with acute  Dietary substances that appear to increase the risk
myeloblastic leukemias (U.S. Department of of cancer include:
Health and Human Services [HHS], 2014) 1. Fats
 Passive smoke (i.e., secondhand smoke) has 2. Alcohol
been linked to lung cancer; nonsmokers who 3. Salt-cured or smoked meats
live with a smoker have about a 20-30% greater 4. Nitrate- and nitrite containing foods
risk of developing lung cancer (HHS, 2014) 5. Red and processed meats
 There is evidence that passive smoke may be
linked with childhood leukemia and cancers of Alcoholic Beverages
the larynx, pharynx, brain, bladder, rectum,
stomach and breast (HHS, 2014)
 Obesity is also associated with an increased risk for
cancers of the pancreas, gallbladder, thyroid, ovary,
and cervix, and for multiple myeloma, Hodgkin
lymphoma, and an aggressive form of prostate
cancer
 Multiple studies have long linked sedentary
lifestyles and lack of regular exercise to cancer
development (Lu, Clague and Bernstein, 2015;
Thompson, McCullough, Wertheim, et al. 2014)
Sedentary Lifestyle
 Hormonal Agents
 Hormonal changes related to the female
reproductive cycle are also associated with cancer
incidence. Early onset of menses before age 12 and
delayed onset of menopause after age 55, null
parity (never giving birth), and delayed childbirth
after age 30 are all associated with an increased risk
of breast cancer. Increased numbers of pregnancies
are associated with a decreased incidence of breast,
endometrial, and ovarian cancers
 Predisposing Factors
1. AGE
 Older individuals are more prone to cancer. They
have more exposure to carcinogens
2. SEX
 Women are more prone to breast, uterus and cervix
cancer
 Men are more prone to prostate and lung cancer
3. STRESS
 Depression, grief, anger, aggression, despair or life
stresses decrease immunocompetence (affects
hypothalamus and pituitary gland)
 Immunodeficiency may spur the growth and
proliferation of cancer cells
 Continuous unmanaged stress that keeps hormones
such as epinephrine and cortisol at high levels can
result in systemic ‘fatigue’ and impaired
immunologic surveillance
4. OBESITY
 Studies have linked obesity to breast and colorectal
cancer
5. HEREDITY
 Greater risk with positive family history (it runs
in the blood; if one family member has cancer,
you probably will have cancer)
6. OCCUPATION
 E.g., Chemical factory workers (exposure to
chemicals), farmers (too much sun exposure),
radiology department personnel (X-rays, MRI,
Ultrasound)
7. URBAN vs. RURAL RESIDENCE
 Cancer is most common among urban dwellers
than rural residents (because of greater
exposure to carcinogens); too much pollution
8. PRECANCEROUS LESIONS
 May undergo transformation into cancer lesions
and tumors
 E.g., Pigmented moles, burn scars, senile
keratosis, leukoplakia, benign polyps/adenoma
of the colon or stomach, fibrocystic disease of
the breast
 Leukoplakia
9. GEOGRAPHIC DISTRIBUTION
 E.g., Cancer of the stomach in Japan, cancer of the
breast in U.S. – Japanese are fond of raw foods that
may have contributed to possible cancer of stomach
 Due to influence of environmental factors as
national diet, ethnic customs and type of pollutions

10. RACE
 Cancer can affect any population
 However, African-Americans experience a higher
rate of cancer than any other racial or ethnic group

American Cancer Society’s Warning Signs of Cancer

C - Change in bowel or bladder habits
A - A sore that does not heal
U - Unusual bleeding or discharge
U - Unexplained sudden weight loss
U - Unexplained anemia (too low hemoglobin;
normal hgb in females= 12-16 g/dL
normal hgb in males = 13-18 g/dL ;
lower than 12 in women and lower than 13 in men is
anemia)
T - Thickening or lump in the breast or elsewhere
I - Indigestion or difficulty in swallowing
O - Obvious change in wart or mole
N - Nagging cough or hoarseness of voice

 Lump in the Breast